Question 1

Elizabeth,an RN with approximately 15 years of service on your unit,walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." According to Havelock (1973),this comment may originate from failure in which phase of the six phases of planned change?

Accepted Answer

A)  Generating self-renewal
B)  Choosing the solution
C)  Diagnosing the problem
D)  Building a relationship D

Question 2

Which of the following are examples of application of the Leadership Rounding Tool? (Select all that apply.)

Accepted Answer

A)  "What is working well for you during bedside reporting?"
B)  "What has not worked for you today?"
C)  "Is there someone on your team who deserves special recognition for her efforts in the implementation?"
D)  "Did you have a good vacation?"
E)  None of the above A,B,C,D

Question 3

Elizabeth is an example of a(n):

Accepted Answer

A)  Early adopter.
B)  Late majority.
C)  Laggard.
D)  Resister. C

Question 4

An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of innovators and early adopters is to:

Accepted Answer

A)  Repeat the benefits of the change.
B)  Share change experiences early in the process.
C)  Initiate frequent interactions among staff.
D)  Provide select information to the staff.

Question 5

To effectively achieve a change goal/outcome in a change situation,the wound care specialist will:

Accepted Answer

A)  Preserve the status quo.
B)  Diminish facilitators and reinforce barriers.
C)  Weigh the strength of forces.
D)  Strengthen facilitating forces.

Question 6

Elizabeth,an RN with approximately 15 years of service on your unit,walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." Which of the following would be the most effective response to Elizabeth?

Accepted Answer

A)  "I understand how you feel, but you are going to have to change."
B)  "It is unfortunate that you feel this way. Others seem quite excited about the new information."
C)  "It is difficult sometimes to change what we know very well. Sometimes it can be frightening."
D)  "Perhaps I can arrange some more information sessions for you, so you can see just how important this change is to patient safety."

Question 7

You anticipate that your region will soon move towards an e-health record system.You begin to discuss this with your staff and are disappointed that you receive little positive response from the staff about this possibility.One staff member,in particular,seems to sum it up by saying "e-health? Won't happen in my working life! There are too many problems with it,like privacy issues." This response is most likely motivated by:

Accepted Answer

A)  Lack of urgency regarding the need to change.
B)  Lack of evidence to support importance of technology.
C)  Deficits in education and experience.
D)  Lack of organizational support for change.

Question 8

As the unit manager on the unit that is leading changes to heparin locks,you find that Elizabeth is very valuable in terms of her observations about other units and her knowledge of organizational processes,and now in discussing the new procedure with others.Elizabeth might be considered an:

Accepted Answer

A)  Engager.
B)  Innovator.
C)  Informal change agent.
D)  Informant.

Question 9

Edith has been vocal about her negative concerns related to a new charting system and frequently expresses the view that keeping the "old system" would have been "just fine." In facilitating change,your best approach to Edith would be to:

Accepted Answer

A)  Put her in the pilot planning group for the change.
B)  Determine if she has considered retirement.
C)  Schedule her work assignment so that it coincides with those of two staff members who are confident with technology and the change.
D)  Avoid discussion of the change, and trust that with sufficient training and information, she will change.

Question 10

The home health agency hired an expert in financial management to evaluate and propose a plan for reversing growing expenses and decreasing revenues.The expert is well respected,both personally and professionally,by members living in this small community.To be effective,staff will need to perceive this change agent as:

Accepted Answer

A)  Trusted, quiet.
B)  Flexible, informal.
C)  Credible, enthusiastic
D)  Communicative, personable.

Question 11

The wound care nurse decided to involve those to be affected by change early in the change management process.This can positively result in:

Accepted Answer

A)  Coordination.
B)  Resistance.
C)  Anticipation.
D)  Participation.

Question 12

The nurse manager frequently interacts with staff and other hospice facility employees.Communication is purposeful because the manager assesses current issues,such as specific satisfactions and dissatisfactions with the newly implemented computerized documentation system.Informally,the manager gathers available staff members to address similar learning needs.Many times,staff members are found coaching other staff about improving use of the new system.According to Senge (1990),the activities demonstrated in this example are:

Accepted Answer

A)  Dialogue, team learning.
B)  Resilience, personal mastery.
C)  Shared vision, systems thinking.
D)  Mental models, teachable moments.

Question 13

Based on Elizabeth's insights and suggestions,you involve pharmacy,only to discover that the change in practice involves practice committees,a medical practice committee,and concerns from administration about potential costs and safety of the proposed change to the IV protocols.The change process at this point is:

Accepted Answer

A)  Linear.
B)  Nonlinear.
C)  Sabotaged.
D)  Neutralized.

Question 14

To engage your staff in awareness of their current practice and how it is affirmed or not by evidence,you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency.You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice.This learning approach is an example of which change management approach?

Accepted Answer

A)  Linear
B)  First-order
C)  Facilitative
D)  Integrative

Question 15

Complex change situations require that the change leader promote ongoing visioning among staff members.One strategy is to:

Accepted Answer

A)  Consciously evaluate invisible mental models.
B)  Allow for individual outcomes.
C)  Encourage cooperative activities.
D)  Operate between order and disorder.

Question 16

Elizabeth,an RN with approximately 15 years of service on your unit,walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." After speaking with Elizabeth a few days later you discover that she is now fine with the change but is concerned that other areas of the organization might resist the change because of perceptions related to patient safety and cost.She suggests that it is important to bring pharmacy on board as they have had previous concerns about the use of heparin.In relation to change theory,this is indicative of:

Accepted Answer

A)  Systems level thinking.
B)  Linear thinking.
C)  Interprofessional collaboration.
D)  First-order change.

Question 17

Resistance is most likely when change:

Accepted Answer

A)  Is not well understood.
B)  Involves many layers in an organization.
C)  Involves nonprofessional workers.
D)  Threatens personal security.

Question 18

To engage your staff in awareness of their current practice and how it is affirmed or not by evidence,you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency.You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice.Staff nurses who gain information on current IV therapy practices are engaging in which phase of Rogers' decision-making process?

Accepted Answer

A)  Persuasion
B)  Knowledge
C)  Confirmation
D)  Decision

Question 19

As the unit manager,you spend a day performing direct patient care and work with a new system that is designed to capture patient documentation at the bedside.During discussions with staff while giving care,you discover that the number of screens that need to be opened during documentation makes charting more complex and time-consuming than traditional manual charting approaches.On the basis of this feedback,you:

Accepted Answer

A)  Assume that the system is doing what it needs to do.
B)  Provide reassurance to staff that the unit has achieved its goals in implementation of the system.
C)  Ask some of the staff if they have had similar experiences with the system.
D)  Consult chart audit data and end user consultation reports to determine if errors and problems are occurring.

Question 20

Sarah,RN,is one of your most enthusiastic staff members and has been to a workshop on preparing educational materials for patients.On the basis of this workshop,she would like to develop an information Website for patients who are being admitted to the ward.An appropriate response to Sarah's suggestion would be:

Accepted Answer

A)  "That is a great suggestion, but we have no resources for such an expensive undertaking right now."
B)  "Perhaps you can keep that in mind as we redesign our charting system."
C)  "We have too many seniors as patients, and you know that they don't use technology."
D)  "There is a great group here that meets to look at technology pilots. Let's see if you can join them and discuss your idea further."

Exam 17: Leading Change